A pilot study has found that cognitive-behavioral couples therapy may be helpful for women with provoked vestibulodynia (PVD) and their partners.
It is estimated that between 4% and 28% of women have PVD, a form of vulvodynia. Women with PVD experience sharp, burning pain when there is contact with the vulvar vestibule. Vaginal intercourse can be very painful for these women. Anxiety and depression are also common and some women fear that their relationship will end because of their pain.
Treatment for PVD can include topical ointments, physical therapy, and/or antidepressants. Typically, treatment does not involve a woman’s partner, even though the situation often affects the couple together as well as the woman alone.
With this in mind, a team of Canadian researchers developed a pilot cognitive-behavioral couples therapy program. Trained therapists worked with nine heterosexual couples in which the woman had PVD. (Because one couple separated during the treatment period, data from the remaining eight couples were included in the analysis.)
The women’s mean age was 26 years; the men’s mean age was 28. On average, the couples had been together for 4.4 years, but PVD was often an issue for the women even before these relationships began.
Each couple attended twelve therapy sessions. Each session lasted for one hour. Over time, the couples learned more about PVD, worked on their communication skills, and discussed issues like anxiety, anticipation, and avoidance of sex. The couples were given homework after each session, which was completed at a mean rate of 65%.
Before and after treatment, the couples completed a wide range of self-report measures to assess intensity and quality of pain, sexual function and satisfaction, pain catastrophizing and self-efficacy, relationship satisfaction, anxiety, depression, and global improvement.
After treatment, the women said they had less pain and better sexual function and satisfaction. Both women and men reported less anxiety and depression after treatment. The couples saw a small increase in relationship satisfaction. However, they did not report much distress at the start of the study. No adverse events were reported.
Overall, 75% of the couples said they had “moderate progress” or “complete resolution” in regard to the woman’s pain. All of the couples reported sexual progress. Both men and women gave the treatment positive ratings.
The researchers called the treatment “promising.” They noted that the therapy may have decreased pain by helping couples better understand their situation and learn strategies for managing it together.
They also acknowledged that this was a pilot study and had its limitations, particularly the small sample size. They noted that the couples were sexually active throughout their treatment. Other couples who avoid sex because of pain might have different results. Also, only heterosexual couples participated. Same-sex couples might have different experiences.
Still, the results of this pilot study suggest that including the partner in PVD treatment can be beneficial.
“[Cognitive-behavioral couples therapy] may represent a potential intervention to reduce pain intensity during intercourse, as well as improve the sexual and psychosocial well-being of women with PVD and their partners,” they wrote.
The study was first published online in July in The Journal of Sexual Medicine.
The Journal of Sexual Medicine
Corsini-Munt, Serena M., MA, et al.
“Feasibility and Preliminary Effectiveness of a Novel Cognitive–Behavioral Couple Therapy for Provoked Vestibulodynia: A Pilot Study”
(Full-text. First published online: July 24, 2014)